Gentile Guendalina, Tambuzzi Stefano, Boracchi Michele, Del Gobbo Alessandro, Bailo Paolo, Zoia Riccardo
Università degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Laboratorio di Istopatologia Forense e Microbiologia Medico Legale, Milano, Italy.
Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Milano, Anatomia Patologica, Milano, Italy.
Autops Case Rep. 2021 Sep 23;11:e2021330. doi: 10.4322/acr.2021.330. eCollection 2021.
Varix of the lower extremities is a common entity that eventually presents fatal outcome. Fatal massive bleeding due to rupture of a peripheral varicose vein is rare. The estimated incidence of these cases is 1/1000 autopsies. The case we present is unique among 26,054 autopsies performed in Milan from 1993 to 2020. It describes the investigations carried out in the suspicion of a non-natural event in an elderly woman. She was found dead at home with a large volume of blood near her feet that drained from the right leg. Pathological examination disclosed that the hemorrhage occurred by the rupture of a venous varix of the lower limb. Cases of fatal hemorrhage from peripheral variceal rupture are insidious and require proper characterization. The bloodstain pattern analysis, careful autopsy dissection by layers to demonstrate the rupture, and histologic examination of the lesion are the essential elements to find out the actual cause of death.
下肢静脉曲张是一种常见病症，最终可能导致致命后果。因外周静脉曲张破裂导致的致命性大出血较为罕见。此类病例的估计发病率为千分之一尸检。我们呈现的这个病例在1993年至2020年于米兰进行的26,054例尸检中是独一无二的。它描述了对一名老年女性疑似非自然事件展开的调查。她被发现死于家中，右脚附近有大量从右腿流出的血液。病理检查显示出血是由下肢静脉静脉曲张破裂所致。外周静脉曲张破裂导致致命出血的病例较为隐匿，需要进行恰当的特征描述。血迹模式分析、逐层仔细的尸检解剖以证明破裂情况以及对病变进行组织学检查是查明实际死因的关键要素。
